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Chanchlani N, Lin S, Auth MK, Lee CL, Robbins H, Looi S, Murugesan SV, Riley T, Preston C, Stephenson S, Cardozo W, Sonwalkar SA, Allah‐Ditta M, Mansfield L, Durai D, Baker M, London I, London E, Gupta S, Di Mambro A, Murphy A, Gaynor E, Jones KDJ, Claridge A, Sebastian S, Ramachandran S, Selinger CP, Borg‐Bartolo SP, Knight P, Sprakes MB, Burton J, Kane P, Lupton S, Fletcher A, Gaya DR, Colbert R, Seenan JP, MacDonald J, Lynch L, McLachlan I, Shields S, Hansen R, Gervais L, Jere M, Akhtar M, Black K, Henderson P, Russell RK, Lees CW, Derikx LAAP, Lockett M, Betteridge F, De Silva A, Hussenbux A, Beckly J, Bendall O, Hart JW, Thomas A, Hamilton B, Gordon C, Chee D, McDonald TJ, Nice R, Parkinson M, Gardner‐Thorpe H, Butterworth JR, Javed A, Al‐Shakhshir S, Yadagiri R, Maher S, Pollok RCG, Ng T, Appiahene P, Donovan F, Lok J, Chandy R, Jagdish R, Baig D, Mahmood Z, Marsh L, Moss A, Abdulgader A, Kitchin A, Walker GJ, George B, Lim Y, Gulliver J, Bloom S, Theaker H, Carlson S, Cummings JRF, Livingstone R, Beale A, Carter JO, Bell A, Coulter A, Snook J, Stone H, Kennedy NA, Goodhand JR, Ahmad T. Implications for sequencing of biologic therapy and choice of second anti-TNF in patients with inflammatory bowel disease: results from the IMmunogenicity to Second Anti-TNF therapy (IMSAT) therapeutic drug monitoring study. Aliment Pharmacol Ther 2022; 56:1250-1263. [PMID: 36039036 PMCID: PMC9804266 DOI: 10.1111/apt.17170] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Revised: 07/05/2022] [Accepted: 07/19/2022] [Indexed: 01/30/2023]
Abstract
BACKGROUND Anti-drug antibodies are associated with treatment failure to anti-TNF agents in patients with inflammatory bowel disease (IBD). AIM To assess whether immunogenicity to a patient's first anti-TNF agent would be associated with immunogenicity to the second, irrespective of drug sequence METHODS: We conducted a UK-wide, multicentre, retrospective cohort study to report rates of immunogenicity and treatment failure of second anti-TNF therapies in 1058 patients with IBD who underwent therapeutic drug monitoring for both infliximab and adalimumab. The primary outcome was immunogenicity to the second anti-TNF agent, defined at any timepoint as an anti-TNF antibody concentration ≥9 AU/ml for infliximab and ≥6 AU/ml for adalimumab. RESULTS In patients treated with infliximab and then adalimumab, those who developed antibodies to infliximab were more likely to develop antibodies to adalimumab, than patients who did not develop antibodies to infliximab (OR 1.99, 95%CI 1.27-3.20, p = 0.002). Similarly, in patients treated with adalimumab and then infliximab, immunogenicity to adalimumab was associated with subsequent immunogenicity to infliximab (OR 2.63, 95%CI 1.46-4.80, p < 0.001). For each 10-fold increase in anti-infliximab and anti-adalimumab antibody concentration, the odds of subsequently developing antibodies to adalimumab and infliximab increased by 1.73 (95% CI 1.38-2.17, p < 0.001) and 1.99 (95%CI 1.34-2.99, p < 0.001), respectively. Patients who developed immunogenicity with undetectable drug levels to infliximab were more likely to develop immunogenicity with undetectable drug levels to adalimumab (OR 2.37, 95% CI 1.39-4.19, p < 0.001). Commencing an immunomodulator at the time of switching to the second anti-TNF was associated with improved drug persistence in patients with immunogenic, but not pharmacodynamic failure. CONCLUSION Irrespective of drug sequence, immunogenicity to the first anti-TNF agent was associated with immunogenicity to the second, which was mitigated by the introduction of an immunomodulator in patients with immunogenic, but not pharmacodynamic treatment failure.
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Azam H, Maher S, Marcone S, Prencipe M. Small-molecule inhibitors of the Serum Response Factor in combination with enzalutamide: New strategy to treat castrate-resistant prostate cancer. EUR UROL SUPPL 2021. [DOI: 10.1016/s2666-1683(21)01196-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Eugene Wong HC, Maher S, Jidon J. Preliminary findings of performing aerosol generating procedures using a novel innovative mask in times of COVID-19 pandemic. Med J Malaysia 2021; 76:20-22. [PMID: 34558552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
This article describes an innovative mask consisting of a newly fabricated 3-ply surgical face mask with a custom made attachment consisting of a plastic dome and a oneway valve port that allows endoscopes to be inserted through it. The mask was tested in-vitro with simulated sneezing using fluorescent dyes and also received positive feedbacks from field tests of 30 masks on real users in different hospitals. This innovative mask is useful in providing extra barrier for endoscopic procedures in ENT and can be used beyond this pandemic in patients with other infectious diseases.
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Affiliation(s)
- H C Eugene Wong
- Universiti Malaysia Sabah, Faculty of Medicine and Health Sciences, Department of Surgery, Kota Kinabalu, Sabah, Malaysia.
| | - S Maher
- Universiti Malaysia Sabah, Faculty of Medicine and Health Sciences, Department of Medical Education, Kota Kinabalu, Sabah, Malaysia
| | - J Jidon
- Universiti Malaysia Sabah, 3Faculty of Engineering, Kota Kinabalu, Sabah, Malaysia
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Abdel-Gaber R, Maher S, Abdel-Gaber R. Morphological Re-description of Camallanus polypteri) Nematoda: Camallanidae) Infecting the African Sharptooth Catfish Clarias gariepinus (Clariidae). Arch Razi Inst 2021; 76:303-309. [PMID: 34223729 DOI: 10.22092/ari.2020.128858.1424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 02/17/2020] [Indexed: 09/30/2022]
Abstract
Fish represents one of the major sources of animal proteins, and different species of fish are susceptible to infections with parasites which cause severe tissue damage and cell destruction of the infected organ. Therefore, in 2019, this parasitological study was conducted to assess the helminth parasites infecting the African sharptooth catfish Clarias gariepinus that were collected from Lake Manzala, Egypt. Only nematode parasite was reported as a prevalent infection from the fish stomach with an infection rate of 7.5%. Depending on the seasonal prevalence, the extent of the infection was analyzed. It was indicated that parasite infection was only reported as 15% in the winter season. Morphological and morphometric analyses of the present parasite species revealed that it possesses all the characteristics of the Camallanus genus, whereas it is closely related to Camallanus polypteri described previously. It is characterized by the presence of a buccal capsule with longitudinal internal ridges, some of which are very short and ranged from 8-14 in males and 8-9 in females. The esophagus consisted of muscular and glandular portions, the middle position of the excretory pore to the muscular esophagus, the anterior location of deirids to the nerve ring, posterior end of males with two unequal spicules and caudal papillae; nonetheless, it is smooth and straight in females. In addition, some morphology and measurement differences for the different body parts were identified with other Camallanus species. Therefore, the present study can provide a full morphologically re-description of Camallanus polypteri with a new geographical location in the Egyptian freshwater.
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Affiliation(s)
- R Abdel-Gaber
- Zoology Department, Faculty of Science, Cairo University, Cairo, Egypt
| | - S Maher
- Zoology Department, Faculty of Women for Arts, Science and Education, Ain Shams University, Heliopolis, Egypt
| | - R Abdel-Gaber
- Zoology Department, Faculty of Science, Cairo University, Cairo, Egypt.,Zoology Department, College of Science, King Saud University, Riyadh, Saudi Arabia.,Zoology Department, Faculty of Science, Cairo University, Cairo, Egypt
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Brayden D, Hill T, Fairlie D, Maher S, Mrsny R. Systemic delivery of peptides by the oral route: Formulation and medicinal chemistry approaches. Adv Drug Deliv Rev 2020; 157:2-36. [PMID: 32479930 DOI: 10.1016/j.addr.2020.05.007] [Citation(s) in RCA: 120] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 05/18/2020] [Accepted: 05/19/2020] [Indexed: 02/07/2023]
Abstract
In its 33 years, ADDR has published regularly on the po5tential of oral delivery of biologics especially peptides and proteins. In the intervening period, analysis of the preclinical and clinical trial failures of many purported platform technologies has led to reflection on the true status of the field and reigning in of expectations. Oral formulations of semaglutide, octreotide, and salmon calcitonin have completed Phase III trials, with oral semaglutide being approved by the FDA in 2019. The progress made with oral peptide formulations based on traditional permeation enhancers is against a background of low and variable oral bioavailability values of ~1%, leading to a current perception that only potent peptides with a viable cost of synthesis can be realistically considered. Desirable features of candidates should include a large therapeutic index, some stability in the GI tract, a long elimination half-life, and a relatively low clearance rate. Administration in nanoparticle formats have largely disappointed, with few prototypes reaching clinical trials: insufficient particle loading, lack of controlled release, low epithelial particle uptake, and lack of scalable synthesis being the main reasons for discontinuation. Disruptive technologies based on engineered devices promise improvements, but scale-up and toxicology aspects are issues to address. In parallel, medicinal chemists are synthesizing stable hydrophobic macrocyclic candidate peptides of lower molecular weight and with potential for greater oral bioavailability than linear peptides, but perhaps without the same requirement for elaborate drug delivery systems. In summary, while there have been advances in understanding the limitations of peptides for oral delivery, low membrane permeability, metabolism, and high clearance rates continue to hamper progress.
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Beyzaei N, Bao S, Maher S, Silvestri R, Walters A, Dorffner G, Kloesch G, Spruyt K, Ipsiroglu O. Using pictograms to make 'structured behavioural observations' of youth with restless legs syndrome reproducible. Sleep Med 2019. [DOI: 10.1016/j.sleep.2019.11.099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Maher S, Ekstrom T, Ongur D, Levy DL, Norton DJ, Nickerson LD, Chen Y. Functional disconnection between the visual cortex and right fusiform face area in schizophrenia. Schizophr Res 2019; 209:72-79. [PMID: 31126803 DOI: 10.1016/j.schres.2019.05.016] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 03/28/2019] [Accepted: 05/06/2019] [Indexed: 11/16/2022]
Abstract
Patients with schizophrenia show impairment in processing faces, including facial affect and face detection, but the underlying mechanisms are unknown. We used functional magnetic resonance imaging (fMRI) to characterize resting state functional connectivity between an independent component analysis (ICA)-defined early visual cortical network (corresponding to regions in V1, V2, V3) and a priori defined face-processing regions (fusiform face area [FFA], occipital face area [OFA], superior temporal sulcus [STS] and amygdala) using dual regression in 20 schizophrenia patients and 26 healthy controls. We also investigated the association between resting functional connectivity and neural responses (fMRI) elicited by a face detection paradigm in a partially overlapping sample (Maher et al., 2016) that used stimuli equated for lower-level perceptual abilities. Group differences in functional connectivity were found in right FFA only; controls showed significantly stronger functional connectivity to an early visual cortical network. Functional connectivity in right FFA was associated with (a) neural responses during face detection in controls only, and (b) perceptual detection thresholds for faces in patients only. The finding of impaired functional connectivity for right FFA (but not other queried domain-specific regions) converges with findings investigating face detection in an overlapping sample in which dysfunction was found exclusively for right FFA in schizophrenia during face detection.
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Affiliation(s)
- S Maher
- McLean Hospital, Harvard Medical School, United States of America.
| | - T Ekstrom
- McLean Hospital, Harvard Medical School, United States of America
| | - D Ongur
- McLean Hospital, Harvard Medical School, United States of America
| | - D L Levy
- McLean Hospital, Harvard Medical School, United States of America
| | - D J Norton
- McLean Hospital, Harvard Medical School, United States of America
| | - L D Nickerson
- McLean Hospital, Harvard Medical School, United States of America
| | - Y Chen
- McLean Hospital, Harvard Medical School, United States of America
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Kumarasinghe APW, Inderjeeth C, Maher S, Chakera A, Dogra S, Chan K. 122CLINICIAN ATTITUDES REGARDING THE UTILITY OF FRAILTY TOOLS IN MANAGING OLDER ADULTS WITH END STAGE KIDNEY DISEASE: LITERATURE REVIEW AND SURVEY STUDY. Age Ageing 2019. [DOI: 10.1093/ageing/afy204.15] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | | | | | - A Chakera
- Departments of Geriatrics
- Nephrology Sir Charles Gairdner Hospital, Nedlands, Western Australia. WA
| | - S Dogra
- Departments of Geriatrics
- Nephrology Sir Charles Gairdner Hospital, Nedlands, Western Australia. WA
| | - K Chan
- Departments of Geriatrics
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Bristow R, Young I, Pemberton A, Williams J, Maher S. An extensive review of the extraction techniques and detection methods for the taste and odour compound geosmin (trans-1, 10-dimethyl-trans-9-decalol) in water. Trends Analyt Chem 2019. [DOI: 10.1016/j.trac.2018.10.032] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Basit H, Maher S, Forster RJ, Keyes TE. Electrochemically Triggered Release of Reagent to the Proximal Leaflet of a Microcavity Supported Lipid Bilayer. Langmuir 2017; 33:6691-6700. [PMID: 28614663 DOI: 10.1021/acs.langmuir.7b01069] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
A novel and versatile approach to electrichemically triggering the release of a reagent, β-cyclodextrin (β-CD), selectively to the proximal leaflet of a supported lipid bilayer is described. Selective delivery is achieved by creating a spanning lipid bilayer across a microcavity array and exploiting the irreversible redox disassembly of the host-guest complex formed between thiolated ferrocene (Fc) and β-cyclodextrin (β-CD) in the presence of chloride. Self-assembled monolayers of the ferrocene-alkanethiols were formed regioselectively on the interior surface of highly ordered 2.8 μm cavities while the exterior top surface of the array was blocked with a monolayer of mercaptoethanol. The Fc monolayers were complexed with β-CD or β-CD-conjugated to streptavidin (β-CD-SA). Phospholipid bilayers were then assembled across the array via combined Langmuir-Blodgett/vesicle fusion leading to a spanning bilayer suspended across the aqueous filled microcavities. Upon application of a positive potential, ferrocene is oxidized to ferrocinium cation, disrupting the inclusion complex and leading to the release of the β-CD into the microcavity solution where it diffuses to the lower leaflet of the suspended bilayer. Disassembly of the supramolecular complex within the cavities and binding of the β-CD-SA to a biotinylated bilayer was followed by voltammetry and impedance spectroscopy where it caused a large increase in membrane resistance. For unmodified β-CD, the extraction of cholesterol from a cholesterol containing bilayer was evident in a decrease in the bilayer resistance. For the first time, this direct approach to targeted delivery of a reagent to the proximal layer of a lipid bilayer offers the potential to build models of bidirectional signaling (inside-out vs outside-in) in cell membrane model systems.
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Affiliation(s)
- H Basit
- School of Chemical Sciences, National Centre for Sensors Research, Dublin City University , Dublin 9, Ireland
| | - S Maher
- School of Chemical Sciences, National Centre for Sensors Research, Dublin City University , Dublin 9, Ireland
| | - R J Forster
- School of Chemical Sciences, National Centre for Sensors Research, Dublin City University , Dublin 9, Ireland
| | - T E Keyes
- School of Chemical Sciences, National Centre for Sensors Research, Dublin City University , Dublin 9, Ireland
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Moody H, Lind M, Maher S. MicroRNA-31 regulates chemosensitivity in malignant pleural mesothelioma via altered intracellular drug localisation. Eur J Cancer 2016. [DOI: 10.1016/s0959-8049(16)61493-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Bibby B, Cawthorne C, Reynolds J, Maher S. MicroRNA-330-5p downregulation in oesophageal adenocarcinoma is a potential therapeutic target for enhancing chemoradiation sensitivity in patients. Eur J Cancer 2016. [DOI: 10.1016/s0959-8049(16)61559-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Moore CS, Wood TJ, Cawthorne C, Hilton KL, Maher S, Saunderson JR, Archibald S, Beavis AW. A method to calibrate the RS 2000 x-ray biological irradiator for radiobiological flank irradiation of mice. Biomed Phys Eng Express 2016. [DOI: 10.1088/2057-1976/2/3/037001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Maher S, Ekstrom T, Tong Y, Nickerson LD, Frederick B, Chen Y. Greater sensitivity of the cortical face processing system to perceptually-equated face detection. Brain Res 2016; 1631:13-21. [PMID: 26592952 DOI: 10.1016/j.brainres.2015.11.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Revised: 11/04/2015] [Accepted: 11/05/2015] [Indexed: 11/30/2022]
Abstract
Face detection, the perceptual capacity to identify a visual stimulus as a face before probing deeper into specific attributes (such as its identity or emotion), is essential for social functioning. Despite the importance of this functional capacity, face detection and its underlying brain mechanisms are not well understood. This study evaluated the roles that the cortical face processing system, which is identified largely through studying other aspects of face perception, play in face detection. Specifically, we used functional magnetic resonance imaging (fMRI) to examine the activations of the fusifom face area (FFA), occipital face area (OFA) and superior temporal sulcus (STS) when face detection was isolated from other aspects of face perception and when face detection was perceptually-equated across individual human participants (n=20). During face detection, FFA and OFA were significantly activated, even for stimuli presented at perceptual-threshold levels, whereas STS was not. During tree detection, however, FFA and OFA were responsive only for highly salient (i.e., high contrast) stimuli. Moreover, activation of FFA during face detection predicted a significant portion of the perceptual performance levels that were determined psychophysically for each participant. This pattern of result indicates that FFA and OFA have a greater sensitivity to face detection signals and selectively support the initial process of face vs. non-face object perception.
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Affiliation(s)
- S Maher
- McLean Hospital, Department of Psychiatry, Harvard Medical School, United States
| | - T Ekstrom
- McLean Hospital, Department of Psychiatry, Harvard Medical School, United States
| | - Y Tong
- McLean Hospital, Department of Psychiatry, Harvard Medical School, United States
| | - L D Nickerson
- McLean Hospital, Department of Psychiatry, Harvard Medical School, United States
| | - B Frederick
- McLean Hospital, Department of Psychiatry, Harvard Medical School, United States
| | - Y Chen
- McLean Hospital, Department of Psychiatry, Harvard Medical School, United States.
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Maher S, Mashhoon Y, Ekstrom T, Lukas S, Chen Y. Deficient cortical face-sensitive N170 responses and basic visual processing in schizophrenia. Schizophr Res 2016; 170:87-94. [PMID: 26690888 PMCID: PMC4707115 DOI: 10.1016/j.schres.2015.12.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Revised: 12/05/2015] [Accepted: 12/08/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND Face detection, an ability to identify a visual stimulus as a face, is impaired in patients with schizophrenia. It is unclear whether impaired face processing in this psychiatric disorder results from face-specific domains or stems from more basic visual domains. In this study, we examined cortical face-sensitive N170 response in schizophrenia, taking into account deficient basic visual contrast processing. METHODS We equalized visual contrast signals among patients (n=20) and controls (n=20) and between face and tree images, based on their individual perceptual capacities (determined using psychophysical methods). We measured N170, a putative temporal marker of face processing, during face detection and tree detection. RESULTS In controls, N170 amplitudes were significantly greater for faces than trees across all three visual contrast levels tested (perceptual threshold, two times perceptual threshold and 100%). In patients, however, N170 amplitudes did not differ between faces and trees, indicating diminished face selectivity (indexed by the differential responses to face vs. tree). CONCLUSION These results indicate a lack of face-selectivity in temporal responses of brain machinery putatively responsible for face processing in schizophrenia. This neuroimaging finding suggests that face-specific processing is compromised in this psychiatric disorder.
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Affiliation(s)
| | | | | | | | - Y Chen
- McLean Hospital, Harvard Medical School, United States.
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Abstract
Facial emotion perception impairment in schizophrenia is currently viewed as abnormal affective processing. Facial emotion perception also relies on visual processing. Yet, visual cortical processing of facial emotion is not well understood in this disorder. We measured perceptual thresholds for detecting facial fear and happiness in patients (n=23) and controls (n=23), and adjusted emotion intensity of facial stimuli (via morphing between images of neutral and emotive expressions) for each subject. We then evaluated activations of the visual cortex and amygdala during the performance of perceptually-equated facial emotion detection tasks. Patients had significantly lower fear- and happiness-induced activations in the visual cortex and amygdala. Activations between the visual cortex and amygdala were largely correlated, but the correlations in patients occurred abnormally early in response time course during fear perception. In schizophrenia, visual processing of facial emotion is deficient and visual and affective processing of negative facial emotion may be prematurely associated.
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Affiliation(s)
- S Maher
- McLean Hospital, Harvard Medical School
| | - T Ekstrom
- McLean Hospital, Harvard Medical School
| | - Y Chen
- McLean Hospital, Harvard Medical School
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Mongan AM, Lynam-Lennon N, Casey R, Maher S, Pidgeon G, Reynolds JV, O'Sullivan J. Visceral obesity stimulates anaphase bridge formation and spindle assembly checkpoint dysregulation in radioresistant oesophageal adenocarcinoma. Clin Transl Oncol 2015; 18:632-40. [PMID: 26474871 DOI: 10.1007/s12094-015-1411-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Accepted: 09/14/2015] [Indexed: 01/04/2023]
Abstract
PURPOSE Oesophageal adenocarcinoma is an exemplar model of obesity-associated cancer. Locally advanced disease is treated with neoadjuvant chemoradiotherapy, and survival rates are highest in patients demonstrating a pathological response following neoadjuvant therapy. Given that 55 % of oesophageal adenocarcinoma patients are obese, uncovering the effect of adipose tissue on radioresponse is clinically relevant. This study investigates if adipose tissue activates genomic instability events in radioresponsive (OE33P) and radioresistant (OE33R) oesophageal cancer cell lines and tumour samples. METHODS OE33R and OE33P were cultured with adipose-conditioned media derived from oesophageal adenocarcinoma patients (n = 10). Anaphase bridges, a marker of genomic instability, were enumerated in both cell lines following treatment with adipose media, and normalised to cell number. Genomic instability is regulated by the spindle assembly complex. Expression of two spindle assembly complex genes (MAD2L2, BUB1B) was assessed using qPCR, and validated in patient tumour specimens from viscerally obese (n = 46) and nonobese patients (n = 41). RESULTS Adipose-conditioned media increased anaphase bridging in OE33R (p < 0.0001), with a threefold increase in OE33R compared to OE33P (p < 0.01). Levels of anaphase bridges in OE33R cells correlated with visceral obesity status as measured by waist circumference (R = 0.709, p = 0.03) and visceral fat area (R = 0.794, p = 0.006). Adipose tissue altered expression of MAD2L2 in vitro. In vivo, MAD2L2 expression was higher in viscerally obese oesophageal adenocarcinoma patients compared with nonobese patients (p < 0.05). CONCLUSIONS Anaphase bridge levels are influenced by obesity and radiosensitivity status in oesophageal adenocarcinoma. Furthermore, visceral adipose-conditioned media stimulates dysregulation of the spindle assembly complex in oesophageal adenocarcinoma patients.
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Affiliation(s)
- A M Mongan
- Department of Surgery, Trinity Centre for Health Sciences, St. James's Hospital, Dublin 8, Ireland
| | - N Lynam-Lennon
- Department of Surgery, Trinity Centre for Health Sciences, St. James's Hospital, Dublin 8, Ireland
| | - R Casey
- Department of Surgery, Trinity Centre for Health Sciences, St. James's Hospital, Dublin 8, Ireland
| | - S Maher
- Cancer Biology & Therapeutics Lab, School of Biological, Biomedical & Environmental Sciences, University of Hull, Cottingham road, Hull, HU6 76X, UK
| | - G Pidgeon
- Department of Surgery, Trinity Centre for Health Sciences, St. James's Hospital, Dublin 8, Ireland
| | - J V Reynolds
- Department of Surgery, Trinity Centre for Health Sciences, St. James's Hospital, Dublin 8, Ireland
| | - J O'Sullivan
- Department of Surgery, Trinity Centre for Health Sciences, St. James's Hospital, Dublin 8, Ireland.
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Onal B, Bowden L, Seedat S, Maher S, Hunter I, Cawkwell L. EP-1199: The identification of putative biomarkers of radioresistance in rectal cancer tissue using antibody microarray. Radiother Oncol 2015. [DOI: 10.1016/s0167-8140(15)41191-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Wortley M, Maher S, Bonvini S, Dubuis E, Nasra J, Holt K, Dockry R, Sen S, Singh D, Smith J, Round P, Gilbert S, Marchant V, Ford J, Birrell M, Belvisi M. P4 Establishing A Role For Trpv1 On Sensory Nerves In Copd Associated Chronic Cough. Thorax 2014. [DOI: 10.1136/thoraxjnl-2014-206260.154] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Maher S, Birrell M, Bonvini S, Wortley M, Dubuis E, Shala F, Jones V, Flajolet P, Negreskul Y, Britton Z, Hebib L, Belvisi M. P6 Menthol Has Beneficial Effects In The Airways Through A Trpm8-independent Mechanism. Thorax 2014. [DOI: 10.1136/thoraxjnl-2014-206260.156] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Syed SUAH, Maher S, Taylor S. Quadrupole mass filter operation under the influence of magnetic field. J Mass Spectrom 2013; 48:1325-1339. [PMID: 24338888 DOI: 10.1002/jms.3293] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2013] [Revised: 09/30/2013] [Accepted: 10/02/2013] [Indexed: 06/03/2023]
Abstract
This work demonstrates resolution enhancement of a quadrupole mass filter (QMF) under the influence of a static magnetic field. Generally, QMF resolution can be improved by increasing the number of rf cycles an ion experiences when passing through the mass filter. In order to improve the resolution, the dimensions of the QMF or the operating parameters need to be changed. However, geometric modifications to improve performance increase the manufacturing cost and usually the size of the instrument. By applying a magnetic field, a low-cost, small footprint instrument with reduced power requirements can be realized. Significant improvement in QMF resolution was observed experimentally for certain magnetic field conditions, and these have been explained in terms of our theoretical model developed at the University of Liverpool. This model is capable of accurate simulation of spectra allowing the user to specify different values of mass spectrometer dimensions and applied input signals. The model predicts enhanced instrument resolution R>26,000 for a CO2 and N2 mixture with a 200-mm long mass filter operating in stability zone 3 via application of an axial magnetic field.
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Affiliation(s)
- S U A H Syed
- Department of Electrical Engineering and Electronics, University of Liverpool, Liverpool, L69 3GJ, UK
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Musial K, Zwolinska D, Pruthi R, Sinha M, Casula A, Lewis M, Tse Y, Maxwell H, O'Brien C, Inward C, Sharaf E, Fadel F, Bazaraa H, Hegazy R, Essam R, Manickavasagar B, Shroff R, McArdle A, Ledermann S, Shaw V, Van't Hoff W, Paudyal B, Prado G, Schoeneman M, Nepal MK, Feygina V, Bansilal V, Tawadrous H, Mongia AK, Melk A, Kracht D, Doyon A, Zeller R, Litwin M, Duzowa A, Sozeri B, Bayzit A, Caliskan S, Querfeld U, Wuhl E, Schaefer F, Schmidt B, Canpolat N, Caliskan S, Kara Acar M, Pehlivan S, Tasdemir M, Sever L, Nusken E, Taylan C, von Gersdorff G, Schaller M, Barth C, Dotsch J, Roomizadeh P, Gheissari A, Abedini A, Garzotto F, Zanella M, Kim J, Cena R, Neri M, Nalesso F, Brendolan A, Ronco C, Canpolat N, Sever L, Celkan T, Lacinel S, Tasdemir M, Keser A, Caliskan S, Taner Elmas A, Tabel Y, Ipek S, Karadag A, Elmas O, Ozyalin F, Hoxha (Qosja) A, Gjyzari A, Tushe E, Said RM, Abdel Fattah MA, Soliman DA, Mahmoud SY, Hattori M, Uemura O, Hataya H, Ito S, Hisano M, Ohta T, Fujinaga S, Kise T, Goto Y, Matsunaga A, Hashimoto T, Tsutsumi Y, Ito N, Akizawa T, Maher S, Cho BS, Choi YM, Suh JS, Farid F, El-Hakim I, Salman M, Rajnochova Bloudickova S, Viklicky O, Seeman T, Yuksel S, Caglar M, Becerir T, Tepeli E, Calli Demirkan N, Yalcin N, Ergin A, Hladik M, Sigutova R, Vsiansky F, Safarcik K, Svagera Z, Abd El Monem Soliman N, Bazaraa HM, Nabhan MM, Badr AM, Abd El Latif Shahin M, Skrzypczyk P, Panczyk-Tomaszewska M, Roszkowska-Blaim M, Wawer Z, Bienias B, Zajaczkowska M, Szczepaniak M, Pawlak-Bratkowska M, Tkaczyk M, Kilis-Pstrusinska K, Jakubowska A, Prikhodina L, Ryzhkova O, Poltavets N, Polyakov V. Paediatric nephrology II. Nephrol Dial Transplant 2013. [DOI: 10.1093/ndt/gft157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Mohan HM, Collins D, Maher S, Walsh EG, Winter DC, O'Brien PJ, Brayden DJ, Baird AW. The mycotoxin patulin increases colonic epithelial permeability in vitro. Food Chem Toxicol 2012; 50:4097-102. [PMID: 22906760 DOI: 10.1016/j.fct.2012.07.036] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2012] [Revised: 07/18/2012] [Accepted: 07/19/2012] [Indexed: 01/11/2023]
Abstract
The gastrointestinal lumen is directly exposed to dietary contaminants, including patulin, a mycotoxin produced by moulds. Patulin is known to increase permeability across intestinal Caco-2 monolayers. This study aimed to determine the effect of patulin on permeability, ion transport and morphology in isolated rat colonic mucosae. Mucosal sheets were mounted in Ussing chambers and voltage clamped. Apical addition of patulin (100-500 μM) rapidly reduced transepithelial electrical resistance (TEER) and increased permeability to [(14)C] mannitol (2.9-fold). Patulin also inhibited carbachol-induced electrogenic chloride secretion and histological evidence of mucosal damage was observed. To examine potential mechanisms of action of patulin on colonic epithelial cells, high-content analysis of Caco-2 cells was performed and this novel, quantitative fluorescence-based approach confirmed its cytotoxic effects. With regard to time course, the cytotoxicity determined by high content analysis took longer than the almost immediate reduction of electrical resistance in isolated mucosal sheets. These data indicate patulin is not only cytotoxic to enterocytes but also has the capacity to directly alter permeability and ion transport in intact intestinal mucosae. These data corroborate and extend findings in intestinal cell culture monolayers, and further suggest that safety limits on consumption of patulin may be warranted.
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Affiliation(s)
- H M Mohan
- UCD School of Veterinary Medicine, University College Dublin, Belfield, Dublin 4, Ireland
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Mongan A, Lynam-Lennon N, Maher S, Reynolds J, Pidgeon G, O'Sullivan J. 523 Levels of Anaphase Bridge Formation and Spindle Assembly Checkpoint Genes Are Significantly Affected by Obesity and Radiosensitivity Status in Oesophageal Cancer Patients. Eur J Cancer 2012. [DOI: 10.1016/s0959-8049(12)71183-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Habib F, El-Mahdy M, Abdel-Hafez A, Maher S. Microemulsion for ocular delivery: ocular irritancy test and in vivo studies of anti-inflammatory action. J Drug Deliv Sci Technol 2012. [DOI: 10.1016/s1773-2247(12)50093-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Casey M, Eime R, Payne W, Harvey J, Bellamy M, Maher S. Participation in sport and physical activity for rural adolescent girls: A socio-ecological approach. J Sci Med Sport 2009. [DOI: 10.1016/j.jsams.2008.12.084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Otago L, Adamcewicz E, Eime R, Maher S. The epidemiology of head, face and eye injuries to female lacrosse players in Australia. Int J Inj Contr Saf Promot 2007; 14:259-61. [DOI: 10.1080/17457300701602381] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Maher S. 419 The role and reasons for injury surveillance in womens lacrosse. J Sci Med Sport 2005. [DOI: 10.1016/s1440-2440(17)30917-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Otago L, Garnham J, Reynolds M, Spittle M, Payne W, Finch C, Maher S. 358 Parental perceptions of sports injury risk. J Sci Med Sport 2005. [DOI: 10.1016/s1440-2440(17)30855-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Loh PK, Ramesh P, Maher S, Saligari J, Flicker L, Goldswain P. Can patients with dementia be assessed at a distance? The use of Telehealth and standardised assessments. Intern Med J 2004; 34:239-42. [PMID: 15151669 DOI: 10.1111/j.1444-0903.2004.00531.x] [Citation(s) in RCA: 77] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Telehealth could be a medium for the provision of cognitive assessments to distant sites. AIMS The aims of the present study were to determine the interrater reliability of the Standardized Mini Mental State Exam (SMMSE) and the Geriatric Depression Scale (GDS) through Telehealth as compared to face-to-face administration. METHODS Duplicate interviews of subjects with crossover of interview modality were carried out. Twenty patients were interviewed between two sites 11 km apart. Subjects were persons older than 65 years (mean age 82 years) who consented to Telehealth assessments. The outcome measures were the differences in assessment scores between the two media. RESULTS The average SMMSE score by remote assessment was 24.0 (range 11.0-30.0) and by direct assessment was 24.3 (range 9.0-30.0). The correlation between direct and remote SMMSE scores was 0.90. The mean difference between direct and remote SMMSE scores was -0.3 (95% confidence interval (CI): -4.6 to 4.0). In 8 of 20 participants (40%) the difference between Telehealth and direct assessments was two points or more on the SMMSE. The average GDS by remote assessment was 6.1 (range 1.0-14.0) and by direct assessment was 5.8 (range 2.0-13.0). The correlation between direct and remote GDS scores was 0.78. The mean difference between direct and remote GDS assessment was 0.3 (95% CI: -3.8 to 4.4). CONCLUSION Remote assessments with SMMSE and GDS using Telehealth methods yielded similar results to direct assessments. However, there was a moderate difference between face-to-face and Telehealth assessments in some subjects, which could influence clinical decision-making.
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Affiliation(s)
- P K Loh
- University of Western Australia School of Medicine and Pharmacology, Perth, Western Australia, Australia.
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Abstract
BACKGROUND Preterm births in the United States increased from 11.0% to 11.4% between 1996 and 1997; they continue to be a complex healthcare problem in the United States. OBJECTIVE The objective of this research was to compare traditional statistical methods with emerging new methods called data mining or knowledge discovery in databases in identifying accurate predictors of preterm births. METHOD An ethnically diverse sample (N = 19,970) of pregnant women provided data (1,622 variables) for new methods of analysis. Preterm birth predictors were evaluated using traditional statistical and newer data mining analyses. RESULTS Seven demographic variables (maternal age and binary coding for county of residence, education, marital status, payer source, race, and religion) yielded a .72 area under the curve using Receiving Operating Characteristic curves to test predictive accuracy. The addition of hundreds of other variables added only a .03 to the area under the curve. CONCLUSION Similar results across data mining methods suggest that results are data-driven and not method-dependent, and that demographic variables offer a small set of parsimonious variables with reasonable accuracy in predicting preterm birth outcomes in a racially diverse population.
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Affiliation(s)
- L K Goodwin
- Health Systems and Primary Care, and School of Nursing and Community and Family Health Medicine, Duke University, Durham, NC, USA.
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Maher S. Assessing age-related sleep disorders. Nurs Older People 2001; 13:27-8. [PMID: 12008243 DOI: 10.7748/nop.13.3.27.s13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Goodwin L, Maher S, Ohno-Machado L, Iannacchione MA, Crockett P, Dreiseitl S, Vinterbo S, Hammond W. Building knowledge in a complex preterm birth problem domain. Proc AMIA Symp 2000:305-9. [PMID: 11079894 PMCID: PMC2243761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023] Open
Abstract
Data mining methods used a racially diverse sample (n = 19,970) of pregnant women and 1,622 variables that were collected in Duke's TMR electronic patient record over a 10-year period. Different statistical and data mining methods were similar when compared using receiver operating characteristic (ROC) curves. Best results found that seven demographic variables yielded .72 and addition of hundreds of other clinical variables added only .03 to the area under the curve (AUC). Similar results across methods suggest that results were data-driven and not method-dependent, and that demographic variables may offer a small set of parsimonious variables with predictive accuracy in a racially diverse population. Work to determine relevant variables for improved predictive accuracy is ongoing.
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Forsyth JP, Kollins S, Palav A, Duff K, Maher S. Has behavior therapy drifted from its experimental roots? A survey of publication trends in mainstream behavioral journals. J Behav Ther Exp Psychiatry 1999; 30:205-20. [PMID: 10619545 DOI: 10.1016/s0005-7916(99)00020-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
In recent years it has been suggested that behavior therapy, characterized in part by single-subject designs and an idiographic approach to addressing practical problems, is drifting from its experimental roots. To examine trends in behavior therapy, and to provide an objective index of drift, two archival studies were conducted to identify publication trends in the use of single-subject designs vs. group designs, as well as citations to select basic behavioral science journals. In Study 1, articles appearing in Behavior Therapy from 1970 through 1996 were reviewed and categorized in terms of type of article, design, and citations to experimental journals. Findings from Study 1 suggest declining publication trends in single-subject designs and citations to experimental journals in Behavior Therapy, with a modest increase in the use of group designs over the period. Study 2 was designed to replicate and extend our initial findings by surveying three behavioral journals in addition to Behavior Therapy using the PsychLit database and years covering 1974 through 1996: Behaviour Research and Therapy, Journal of Behavior Therapy and Experimental Psychiatry, and Behavior Modification. Consistent with Study 1, results of Study 2 showed declining trends in single-subject designs for all mainstream behavioral journals. The significance of these findings in light of the argument that behavior therapy has drifted from its experimental roots is discussed, with emphasis on contingencies that may be responsible for the trends observed.
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Affiliation(s)
- J P Forsyth
- Department of Psychology, University at Albany, State University of New York, 12222, USA.
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Lee TC, Shine JD, FitzPatrick DP, Bradley JA, O’Connor JJ, O’Kelly KU, Carr AJ, McCormack BAO, O’Neill P, Cole JS, Watterson JK, Raghunathan S, O’Reilly MJG, Pherwani A, Rice J, McCormack D, Maher SA, Prendergast PJ, Reid AJ, Waide DV, Chambers SD, Bartlett RH, Ceccio SL, Murphy LA, Lacroix D, Murphy BP, Mullett H, Shannon F, Lawlor G, O’Rourke SK, Connolly P, Maher S, Devitt A, McElwain J, O’Reilly P, McCarthy DR, Kernohan G, Buchanan FJ, Sim B, Downes S, Bennett DB, Orr JF, Dorrell PF, Fleming P, Stephens M, Moholkar K, Fenelon G, Doyle AM, Dockrell S, Normoyle P, Geraghty D, MacNamara S, Lacey G, Lally C, McGloughlin T, Grace P, Walsh M, McGIoughlin T, Colgan D, Daly S, Dolan B, Flynn MJ, Shuhaibar M, Neligan MC, McMillan ND, O’Mongain E, Walsh J, Miller R, Mitchell I, O’Neill M, Brennan F, Ridgway P, Blayney AW, Monkhouse WS, O’Brien FJ, Taylor D, Mushipe MT, Shelton JC, Revell PA, McCarthy MA, Pearse KM, O’Keefe DT, Lyons GM, Leane GE, Mulcahy E, Bray K, Conway BA, Halliday DM, Rosenberg JR, Anderson R, Grace PA, Kinsella SM, Harrison AJ, Lyons DJ, Wallace KE, Hill RG, Pembroke JT, Brown CJ, Hatton PV, Bryan K, Buggy M, Noe JM, Nico AC, McConnell LA, McGivern RC, Marsh DR, Meenan BJ, Workman A, Kuiper JH. Royal Academy of Medicine in Ireland Section of Bioengineering. Ir J Med Sci 1999. [DOI: 10.1007/bf02945855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Samarkandi AH, Al Satli R, Maher S, Al Watidy AF. Surgical removal of a knotted pulmonary artery catheter. Ann Saudi Med 1995; 15:291-2. [PMID: 17590586 DOI: 10.5144/0256-4947.1995.291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- A H Samarkandi
- Divisions of Anesthesia and Cardiac Surgery, Department of Surgery, King Khalid University Hospital, Riyadh, Saudi Arabia
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